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Gout

QuestionAnswer
Gout heterogeneous disorder, deposition of uric acid salt or crystal in or ard joints and soft tissue, or crystallization of uric acid in the urinary tract
stages of gout 1. Asymptomatic hyperuricaemia. 2. Acute gouty arthritis. 3. Intercritical gout. 4. Chronic tophaceous gout.
First line treatment- acute gout attack NSAIDs 1. diclofenac 100mg start then 50mg tds for 2 days, then 50mg bds for 8 days.
2. Naproxen 750mg starts then 250mg tds.
3. Indometacin 75-100mg bds daily then reduce dose after 5 days.
4. Piroxicam 40mg/day start dose then reduce to 10-20mg/day
5. Etoricoxib - only COX2 inhibitor that licensed for gout. - 120mg OD
Colchicine- 2nd line treatment - given asap as the onset of symptom. - starting dose at 1mg then give 0.5mg every 2-3 hrs until pain relief. -s/e: nausea/ vomiting/ diarrhea/ abdominal pain. -max 6mg
corticosteroid IA injection- unlicensed prednisolone- 30mg/day for 7 days.
Probenecid - chronic treatment- prophylaxis - 500mg-1g BD
Sulphinpyrazone - chronic treatment - 100mg tds/qds
Xanthine oxidase inhibitors- allopurinol - 100mg initial dose and increased every 3-4 weeks as necessary. - 100-600mg. - 300mg daily reduce serum urate to normal.
Febuxostat - 40-80mg daily.
Created by: staffi